Provider Demographics
NPI:1467609727
Name:CALLADO, MARIA ELENITA S (NP)
Entity Type:Individual
Prefix:
First Name:MARIA ELENITA
Middle Name:S
Last Name:CALLADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W DUARTE RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7606
Mailing Address - Country:US
Mailing Address - Phone:626-446-4461
Mailing Address - Fax:626-445-0647
Practice Address - Street 1:622 W DUARTE RD STE 202
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9272
Practice Address - Country:US
Practice Address - Phone:626-446-4461
Practice Address - Fax:626-445-0647
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 13938363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467609727Medicare PIN